

<?php
$this->load->view('enrollment/enrollment_modal');
$genderAttrib = array('' => 'Select Gender...', 'male' => 'Male', 'female' => 'Female' );
$child_birth_position = array('first'=>'First','Second'=>'Second','third'=>'Third','fourth'=>'Fourth','fifth'=>'Fifth','sixth'=>'Sixth','youngest'=>'youngest','only'=>'Only');
?>

<div>&nbsp;</div>

		
	<div class="large-12 columns"><h5 class="lead">MEDICAL INFORMATION AND HEALTH HISTORY</h5></div>
	
	<hr class="clearfix">
	
	<div class="large-12 columns">
		<span>1. Does your child have any of the following?</span>
		<?='<br>'.form_error('allergies_reaction');?>
	</div>

	<div class="large-12 columns">
		<span>Allergies (specify if yes)</span>
		<input type="text" name="allergies_reaction" value="<?=set_value('allergies_reaction');?>">
	</div>

	<div class="clearfix"></div>
	
	<div class="large-12 columns">
		<span>Drug Allergies (specify if yes)</span>
		<?='<br>'.form_error('drug_allergies_reaction');?>
		<input type="text" name="drug_allergies_reaction" value="<?=set_value('drug_allergies_reaction');?>">
	</div>
	
	<div class="clearfix"></div>
	
	<div class="large-12 columns">
		<div class="large-4 columns">
			<span>Asthma</span>
			<?=form_radio('asthma', 'no', 'checked');?> No <?=form_radio('asthma', 'yes');?> Yes
		</div>
		<div class="large-8 columns">
			<span>Does your child carry an asthma inhaler?</span>
			<?=form_radio('asthma_inhaler', 'no', 'checked');?> No <?=form_radio('asthma_inhaler', 'yes');?> Yes
		</div>
	</div>
	
	<div class="clearfix"></div>
	
	<div class="large-12 columns">
		<span>Eye or Vision problems (specify if yes)</span>
		<?='<br>'.form_error('eye_problem_spec');?>
		<textarea name="eye_problem_spec"><?=set_value('eye_problem_spec');?></textarea>
	</div>
	
	<div class="large-12 columns">
		<span>Ear or hearing problem(s) specify if yes</span>
		<?='<br>'.form_error('ear_problem_spec');?>
		<textarea name="ear_problem_spec"><?=set_value('ear_problem_spec');?></textarea>
	</div>
	
	<div class="large-12 columns">
		<span>2. Any other health condition that the school should be aware of (e.g. epilepsy, diabetes, etc)</span>
		<?='<br>'.form_error('major_ailment');?>
		<textarea name="major_ailment"><?=set_value('major_ailment');?></textarea>
	</div>
	
	<div class="clearfix"></div>
	
	<div class="large-12 columns">
		<span>3. Has your child recently been hospitalized? Why? / When?</span>
		<?='<br>'.form_error('recently_hospitalized');?>
		<textarea name="recently_hospitalized"><?=set_value('recently_hospitalized');?></textarea>
	</div>
	
	<div class="clearfix"></div>
	
	<div class="large-12 columns">
		<span>4. Has your child recently had any serious injuries: Why? / When?</span>
		<?='<br>'.form_error('major_injury');?>
		<textarea name="major_injury"><?=set_value('major_injury');?></textarea>
	</div>
	
	<div class="clearfix"></div>
	
	<div class="large-12 columns">
		<span>5. Is your child on a regular medication? if yes please specify medication and frequency.</span>
		<?='<br>'.form_error('medication_child_taking_spec');?>
		<textarea name="medication_child_taking_spec"><?=set_value('medication_child_taking_spec');?></textarea>
	</div>
	
	<div class="clearfix"></div>
	
	<div class="large-12 columns">
		<span>6. Does your child need to take any medication/s during school hours?</span> <?=form_radio('medication_child_taking_school_hours', 'no', 'checked');?> No <?=form_radio('medication_child_taking_school_hours', 'yes');?> Yes. 
	</div>
	
	<div class="clearfix"></div>
	
	<div class="alert-box">(If so, a letter from the Medical Doctor must be submitted, and be kept on file and medication(s) will also be kept in the school, to be dispensed only by the teacher or authorized person.)</div>
	
	<div class="clearfix"></div>

	<hr class="clearfix">
	
	<div>
		<a href="#" id="panel_3" class="btn btn-primary">Continue Part 4: Authorization</a>
	</div>



<script>
$( document ).ready(function() {
	$('#panel_3').on('click', function(event) {
		$('#panel1').removeClass("active");
		$('#panel1').css("padding-top", "");
		$('#panel2').removeClass("active");
		$('#panel2').css("padding-top", "");
		$('#panel3').removeClass("active");
		$('#panel3').css("padding-top", "");
		$('#panel4').addClass("active");
		$('#panel4').css("padding-top", "50px");
	});
	
});
</script>